Any qualms about stopping antiretrovirals with intrinsic anti-hep B activity in PLWH or PrEP patients who are Hep B core Ab (IgG) positive, sAg negative?
My understanding is that people with HBcAb are at risk of Hep B reactivation, regardless of HBsAb status. The highest risk is with those getting Rituxan, or higher dose steroids, but the risk is low, not zero, even for folks without immunosuppressive comorbidities or meds.
PLWH might be eligible for regimen simplification with 0-1 drugs with anti-hep B activity. If HBcAb +, HBsAg -, would you still offer Cabenuva or Juluca, or Dovato, assuming they met all other criteria for regimen change? Would current or nadir CD4 count affect your decision?
For PrEP patients HBcAb+, HBsAg-, any concerns about stopping PrEP? I believe iPrEX had six patients who were HBcAb+, sAg+ who got Truvada, and none with Hep B flares after stopping Truvada. That was only six patients though, but I'd think HBsAg- patients would be less risk of reactivation anyway.
Anyone seen any cases of Hep B reactivation in these situations?
Thank you for any input!
Steve Burrows, MD, FAAFP, AAHIVS